Traditionally, surgery is considered the best treatment for oesophageal cancer in
terms of locoregional control and long-term survival. However, survival 5 years after
surgery alone is about 25%, and, therefore, a multidisciplinary approach that includes
surgery, radiotherapy, and chemotherapy, alone or in combination, could prove necessary.
The role of each of these treatments in the management of oesophageal cancer is under
intensive research to define optimum therapeutic strategies. In this report we provide
an update on treatment strategies for resectable oesophageal cancers on the basis
of recent published work. Results of the latest randomised trials allow us to propose
the following guidelines: surgery is the standard treatment, to be used alone for
stages I and IIa, or possibly with neoadjuvant chemotherapy or chemoradiotherapy for
stage IIb disease. For locally advanced cancers (stage III), neoadjuvant chemotherapy
or chemoradiotherapy followed by surgery is appropriate for adenocarcinomas. Chemoradiotherapy
alone should only be considered in patients with squamous-cell carcinomas who show
a morphological response to chemoradiotherapy, and produces a similar overall survival
to chemoradiotherapy followed by surgery, but with less post-treatment morbidity.
Although the addition of surgery to chemotherapy or chemoradiotherapy could result
in improved local control and survival, surgery should be done in experienced hospitals
where operative mortality and morbidity are low. Moreover, surgery should be kept
in mind as salvage treatment in patients with no morphological response or persistent
tumour after definitive chemoradiotherapy.